Proton Pump Inhibitors Linked to Hip Fractures

January 31, 2012 — In 2008, nearly one out of five women took a heartburn medication regularly. Unfortunately, new research published in the British Medical Journal has found that a class of heartburn medications known as Proton Pump Inhibitors (PPIs), which includes popular medications Prilosec and Nexium, may increase a woman’s risk of hip fractures.˜

Women who took a PPI regularly for at least two years were 35% more likely to suffer a hip fracture. Women who smoked and were post-menopausal were at the highest risk of suffering a hip fracture.

You may have one or more PPIs in your medicine cabinet. This group of drugs are among the most popular medications in the world. PPI medications include:

• Aciphex (rabeprazole)
• Dexilant (dexlansoprazole)
• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Prilosec (omeprazole)
• Protonix (pantoprazole)
• Vimovo (naproxen/esomeprazole magnesium)
• Zegerid (omeprazole and sodium bicarbonate)

The study analyzed data on almost 80,000 women who were post-menopausal. During the study, 893 women suffered a fractured hip. Among regular PPI users, there were 2 fractures per 1,000 person-years. Among non-PPI users, there are 1.5 events per 1,000 person-years. When the researchers controlled for factors that might contribute to the higher risk (body mass index, physical activity level, and family history of osteoporosis) they found that the risk remained constantly higher for PPI-users.

In conclusion, the researchers determined that long-term use of PPIs was associated with a higher risk of hip fractures. The risk was even more increased for women who took a PPI for more than two years, with risk increasing with duration of use.

The news will be a warning for thousands of women. The regular use of PPIs has increased dramatically in the last decade. In 2000, around 6.7% of post-menopausal women took a PPI regularly. This number increased dramatically by 2008, when 18.9% of post-menopausal women took a PPI regularly. In eight years, the rate of regular use increased by a three-fold rate.

In response to information about the risk of hip fractures associated with PPIs, the FDA warned of the risk in May 2010. Multiple studies had found possible links between PPIs and bone, wrist, and spinal fractures, but the FDA warned that more research was needed.

The most recent study adds substantial evidence linking PPIs to bone fractures. The authors of the study say that the study’s strengths include its design, large sample size, and the inclusion of risk factors like body mass index, physical activity, and family history of osteoporosis. However, they did not look at the brand-names of PPIs that the subjects were taking, or the dosage that women were taking.

PPIs are used to treat heartburn and acid reflux. Their popularity increased dramatically in 2003, when the FDA approved the medications for over-the-counter sale. In response to reports of hip fractures, the manufacturers have since updated the safety label to include the new information about the risk of hip fractures in long-term users of PPIs. It is important to note, however, that no one has found a risk of fractures for short-term use of these medications.

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